Senior Director Clinical Quality and Policy

Responsibilities

• Provide strategic and operational oversight for Utilization Management, Clinical Review, and Clinical Quality functions.
• Influence provider strategy by helping translate clinical standards, policy expectations, and quality priorities into clear guidance and engagement approaches.
• Help shape the organization's clinical positioning in the marketplace by contributing to thought leadership, external credibility, provider engagement, and strategic partnerships.

Requirements

• 12+ years w/Bachelor's degree; 3+ years management
• Additional Experience
• DDS or DMD required
• Active, unrestricted dental license, or ability to obtain appropriate licensure if required
• Minimum of 10 years of transformational leadership experience in dental, managed care, health plan, payer, or related healthcare environments
• Significant experience in clinical quality, utilization management, clinical review, and clinical policy
• Demonstrated experience in both direct clinical care and administrative leadership
• Experience applying evidence-based practice, clinical research, or scientific literature to clinical policy, quality, or care model decisions
• Proven ability to influence senior leaders and work effectively across a complex, matrixed organization
• Strong strategic thinking and ability to translate clinical expertise into business and operational impact
• Senior-level leadership experience in clinical quality, clinical policy, utilization management, or related roles within a health plan, healthcare organization, or integrated care environment.
• Strong executive presence with the ability to influence, build consensus, and lead through change.
• Knowledge, Skills, Abilities
• Advanced knowledge of managed care principles
• Verbal and written communication skills
• Den

Additional Information

The Senior Director of Clinical Quality & Policy provides enterprise clinical leadership for a transforming dental health plan, ensuring that clinical policy, quality strategy, and utilization management are grounded in evidence-based care, data-driven decision-making, and whole-person health outcomes. This leader will be accountable for key clinical functions including Utilization Management, Clinical Review, and Clinical Quality, while also helping shape the organization's broader clinical positioning in the marketplace and supporting the development of integrated care models that connect oral health to whole person health. The Senior Director brings strong clinical credibility, policy expertise, business acumen, and strategic leadership to help influence enterprise priorities, provider engagement, quality outcomes, and market differentiation. This leader moves confidently between strategy and execution while bringing the credibility to engage with providers and clinical leaders, the business acumen to influence enterprise decisions, and the vision to help position the organization more broadly in the marketplace as a trusted health plan focused on quality, whole person care, and improved outcomes This role operates as a peer executive leader and consensus builder across clinical, operational, and enterprise stakeholders.

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